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UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UST Tank-2 <br /> Page 4 0 8 <br /> IV W2LUCaLEQ0UATInkI <br /> A.PIPING TYPE Ell.ABOVEGROUND ❑1 SUCTION ❑2 PRESSURE ❑3 GRAVITY ❑99 OTHER <br /> Check all that apply ®it ❑1 SUCTION ®2 PRESSURE ❑3 GRAVITY ❑99 OTHER 44B <br /> UNDERGROUND <br /> B.CONSTRUCTION ❑I ABOVEGROUND ❑i SINGLE WALL ❑2 DOUBLE WALL ❑3 LINED TRENCH ❑95 UNKNOWN ❑99 OTHER <br /> Cheek all that apply ®it ®1 SINGLE WALL ❑2 DOUBLE WALL ®3 LINED TRENCH ❑95 UNKNOWN ❑99 OTHER <br /> UNDERGROUND 449 <br /> C.MATERIAL AND ❑i ABOVEGROUND ❑1 BARE STEEL ❑4 FIBERGLASS PIPE ❑B 100%METHANOL COMPATIBLE WRAP ❑11 FLEXIBLE PIPING <br /> CORROSION <br /> PROTECTION ❑2 STAINLESS ❑5 ALUMINUM ❑9 GALVANIZED STEEL ❑95 UNKNOWN <br /> STEEL ❑6 CONCRETE ❑10 CATHODIC PROTECTION ❑99 OTHER <br /> ❑3 PVC ❑7 STEEL W/COATING <br /> ®ii. ❑1 BARE STEEL ®4 FIBERGLASS PIPE ❑8100%METHANOL COMPATIBLE WRAP ❑11 FLEXIBLE PIPING <br /> UNDERGROUND ❑2 STAINLESS ❑5 ALUMINUM ❑9 GALVANIZED STEEL ❑95 UNKNOWN <br /> Cheek all that apply STEEL ❑6 CONCRETE ®10 CATHODIC PROTECTION 1:199 OTHER <br /> ❑3 PVC ❑7 STEEL W/COATING 450 <br /> D.LEAK DETECTION ❑1 MECHANICAL LINE LEAK DETECTOR ®3 CONTINUOUS INTERSTITIAL ®5 AUTOMATIC PUMP SHUTDOWN FOR LEAK DETECTION 8 <br /> Check all Mat apply MONITORING SYSTEM DISCONNECTION&MALFUNCTION <br /> ®2 LINE TIGHTNESS TESTING ❑Be OTHER 450 <br /> ®4 ELECTRONIC LINE LEAK DETECTOR <br /> UST TANK <br /> ❑1 VISUAL CHECK ®4 AUTOMATIC TANK ®7 CONTINUOUS INTERSTITIAL 1:110 MONTHLY 095 UNKNOWN <br /> GAUGING(ATG) MONITORING TANK <br /> TESTING <br /> CSLD set at <br /> 99% <br /> 02 MANUAL INVENTORY ❑S GROUNDWATER MONITORING ❑BSIR ®11 CONTINUOUS ❑99 OTHER 451 <br /> RECONCILIATION ATG <br /> ❑3 VADOSE MONITORING ❑6ANNUAL TANK TESTING ❑9 WEEKLY MANUAL TANK GAUGING ❑91 NONE <br /> VI.TANK CLOSURE INFORMATION(permanent closure M place) <br /> ESTIMATED DATE LAST USED(YR/MO/DAY) ESTIMATED QUANTITY OF WAS TANK FILLED WITH INERT ❑ YES ❑ NO <br /> 452 SUBSTANCE REMAINING at. MATERIAL? <br /> 453 454 <br /> VI.APPLICANT SIGNATURE <br /> 1 certify that the information provided herein is Yue 8 accurate to the best of my knowledge. OWNER/OPERATOR TITLE 457 DATE 456 <br /> OWNER/OPERATOR NAME(printed arM signed) 456 <br /> Diane Leri Retail ESH 08/13/99 <br /> Permit Approved by Pemid Expiration Date <br /> 4 <br /> Formerly SWRCS Form 9 <br />